Abstract
BackgroundAppropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. As part of a larger agenda to create an implementation guideline, we conducted a systematic review to evaluate interventions designed to increase the rate of breast, cervical, and colorectal cancer (CRC) screening. The interventions considered were: client reminders, client incentives, mass media, small media, group education, one-on-one education, reduction in structural barriers, reduction in out-of-pocket costs, provider assessment and feedback interventions, and provider incentives. Our primary outcome, screening completion, was calculated as the overall median post-intervention absolute percentage point (PP) change in completed screening tests.MethodsOur first step was to conduct an iterative scoping review in the research area. This yielded three relevant high-quality systematic reviews. Serving as our evidentiary foundation, we conducted a formal update. Randomized controlled trials and cluster randomized controlled trials, published between 2004 and 2010, were searched in MEDLINE, EMBASE and PSYCHinfo.ResultsThe update yielded 66 studies new eligible studies with 74 comparisons. The new studies ranged considerably in quality. Client reminders, small media, and provider audit and feedback appear to be effective interventions to increase the uptake of screening for three cancers. One-on-one education and reduction of structural barriers also appears effective, but their roles with CRC and cervical screening, respectively, are less established. More study is required to assess client incentives, mass media, group education, reduction of out-of-pocket costs, and provider incentive interventions.ConclusionThe new evidence generally aligns with the evidence and conclusions from the original systematic reviews. This review served as the evidentiary foundation for an implementation guideline. Poor reporting, lack of precision and consistency in defining operational elements, and insufficient consideration of context and differences among populations are areas for additional research.
Highlights
According to the World Health Organization [1], cancer is a leading cause of death worldwide, accounting for 7.6 million deaths in 2008
Literature search results Original review As described, three original systematic reviews targeted ten interventions served as the foundation [8,9,10]
With considered judgement and integration with the data from the original systematic reviews [8,9,10], the Panel concludes that client reminders, small media, and provider audit and feedback appear to be reasonable strategies to increase the uptake of screening for breast, cervical, and colorectal cancer (CRC)
Summary
According to the World Health Organization [1], cancer is a leading cause of death worldwide, accounting for 7.6 million deaths (or 13%) in 2008. Several clinical practice guidelines have been developed to facilitate high-quality screening [e.g., [4,5]]. As with any new health intervention or technology, the uptake and application of clinical recommendations is complex, variable, and at less than optimum rates [6]. Effective strategies to improve the uptake of cancer screening are warranted if the full benefits of screening options are to be realized. In addition to the clinical guidance that already exists, guidance to facilitate effective implementation of cancer screening is required. Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. As part of a larger agenda to create an implementation guideline, we conducted a systematic review to evaluate interventions designed to increase the rate of breast, cervical, and colorectal cancer (CRC) screening. Our primary outcome, screening completion, was calculated as the overall median post-intervention absolute percentage point (PP) change in completed screening tests
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